Workers’ Compensation Injury Reporting Kit
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Step 1: Report Injury Immediately
IN CASE OF EMERGENCY, CALL 911 OR SEEK TREATMENT AT THE CLOSEST MEDICAL FACILITY
Call Adapt HR (888) 991-2939
If the injury occurs after 5:00 PM EST, seek treatment at the nearest medical clinic or hospital. Notify Adapt HR the next business day.
Search approved non-emergency treatment facilities below. Filter by Location → Advanced Search → Select Urgent Care & Urgent Care Center.
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Step 2: Workers' Compensation Injury Reporting Form
Complete and return the Workers’ Compensation Injury Reporting Form within 24 hours.
Complete with DocuSign below, or email completed form to info@adapthr.com
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Step 3: Refusal Of Medical Treatment Form
If the employee declines medical treatment, complete the Refusal of Medical Treatment Form and submit it along with the Workers’ Compensation Injury Reporting Form from Step 2.
Complete with DocuSign below, or email completed form to info@adapthr.com
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Step 4: Complete A Drug Test
Injured workers must complete a drug test within 24 hours of the injury.
Call Adapt HR (888) 991-2939
If the injury occurs after 5:00 PM EST, notify Adapt HR the next business day. We will provide you with the electronic chain of custody and assist with locating the nearest testing facility.
Give to employee for treatment
This packet includes insurance information and temporary prescription card the provider will need to facilitate care.